HIV/STBBI basics

HIV, AIDS, STBBI… It is easy to get lost in all these acronyms. The following section should help you get a better understanding.

HIV and STBBIs

Sexually transmitted and blood-borne infections (STBBIs) are infections transmitted through sex and contact with blood. Some are only transmitted through sex, like chlamydia and gonorrhea. Other infections, like HIV, can be transmitted both sexually and through contact with blood. To find out more about STBBIs, visit the STBBI section of the Portail santé mieux-être (health and wellness portal) of the Government of Quebec.

The human immunodeficiency virus (HIV) is transmitted sexually and through contact with blood. It is an infection for which, so far, there is no cure. Today, the life expectancy of a person living with HIV can be nearly as long as the life expectancy of an uninfected person. In order to maintain good health, people living with HIV need to take daily HIV treatments and be followed closely by a physician.

In Quebec, we are seeing a significant increase in the incidence of STBBIs. Chlamydia is the infection most commonly diagnosed among women. In terms of HIV, women are far less affected than men, but still represent 17% of new diagnosed cases. Transmission mainly occurs through heterosexual sex.

Although some women are at higher risk of an HIV infection, a significant number of women who have been diagnosed with HIV did not have identifiable risk factors. It is therefore important to open up a dialogue about sexual health and promote awareness, among all women, of the different strategies they can use to prevent HIV.

How are STBBIs transmitted?

Sexually transmitted and blood-borne infections (STBBIs) are generally more easily transmitted than HIV. All sexually active women, whether their partners are men or women, are at risk. Very often, there will be no visible symptoms. Remember that having an STBBI increases your risk of contracting or transmitting HIV.

The majority of STBBIs can be treated and cured, and treatment is covered either through your private group insurance plan, or through the RAMQ.

If you do not have a Health Insurance Card, contact your local community HIV organization to learn what options are available to you.

If you are HIV-positive, it is easier to contract another STBBI, and more difficult to treat it. STBBIs can also cause health problems and affect the effectiveness of your HIV treatments. If you are sexually active, it is important to get tested regularly. Speak to your doctor.

HIV is transmitted only when one of these fluids from an HIV-positive person comes in contact with the bloodstream of an uninfected person, for example:

• During a sexual encounter involving penetration of the penis into the vagina or anus• Through blood, when sharing injection materials or inhaling drugs• Through blood, when getting a tattoo or piercing with contaminated needles• From an infected mother to her child during pregnancy, childbirth, or breastfeeding if the mother is not receiving appropriate HIV treatment

And

In rare cases, during fellation if the person performing the act has lesions or infections in their mouth, or visited the dentist in the previous 24 hours.

Genital to genital contact presents a negligible, even non-existent risk of HIV infection. In fact, there is very little risk of HIV transmission during sex between women, except during menstruation or if you engage in practices involving blood.

HIV cannot be transmitted in day-to-day situations, like:

• Using public toilets• Sharing glasses or utensils• Physical contact like holding hands or kissing on the cheek• Sneezing or spitting• Mosquito and other insect bites• Eating, working, or playing sport with an HIV-positive person

Why should I get tested?

If you have never been tested, are starting a new relationship, had sex without a condom, or are pregnant or trying to get pregnant, you should get tested. Getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs) is the only way to detect an infection and get access to medical care and support if you need it.

It is confidential and free. Because these infections don't always have symptoms, getting tested will give you peace of mind and keep you and your partners healthy.

How often should I get tested?

How often you get tested depends on several factors. The most important thing to remember is that getting tested regularly is the best way to quickly detect an infection. You should think about getting tested if:

• You have a new sexual partner• You have multiple sexual partners• You have had sex without a condom• You use drugs• You want to get pregnant

Be proactive. Talk to your doctor. You do not need to wait until he or she brings it up to ask for information about getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs). It is important to be able to speak openly and unreservedly with your healthcare professional. The more they know, the better they will be able to determine what tests you need, and how often you should get tested.

Where and how to get tested?

Every region of Quebec has at least one CLSC offering HIV and STBBI testing. Your local community HIV organization may even offer this service. For more information on the services offered in your area, refer to the Where can I get tested?

Testing is confidential and free for anyone with a valid RAMQ Health Insurance Card. It only takes a few minutes.

You can get tested as of age 14 without parental consent.

Nominal or anonymous testing?

In Quebec, HIV testing can be nominal (using your name), non-nominal (not using your name), or anonymous. For other STBBIs, testing is nominal, in other words, you have to submit your Health Insurance Card. In all cases, your physician is required to respect your medical confidentiality and is not permitted to share your results with a third party without your consent.

Anonymous HIV testing?

At least one CLSC in each region of Quebec offers anonymous HIV testing. At these locations, it is not necessary to present your Health Insurance Card or any other piece of identification, and the service is free. However this service will not be offered to you automatically. You will need to request it when you schedule an appointment.

How is the test done?

You will generally have to meet with a doctor or nurse. Before taking samples, they will usually ask you a few questions to determine which tests to perform. Some of us may feel shy about revealing the number of sexual partners we have had or the type of sexual activities we engage into. Know that anything said during the appointment with the healthcare professional is confidential. The more precise the information you share with your doctor or nurse, the better they will be able to assess which tests are needed.

Next, the doctor or nurse will take samples: this generally involves a blood test, urine test, and swabs from the vagina, throat, and/or anus, for example.

The results of the tests are generally communicated by phone, with the exception of HIV which requires you to return to the clinic for a second visit to hear the results.

There is also the possibility of doing a rapid HIV test. This test is not free, and is typically offered only in specialized clinics. You will get results from this test on the same visit. If you are interested in this option, ask about its availability when you arrive at the clinic.

What if I don’t have a Health Insurance Card?

A Health Insurance Card is generally necessary to get tested for HIV and other sexually transmitted and blood-borne infections (STBBIs).

If you do not have a Health Insurance Card, visit your nearest CLSC. Many CLSCs will see you even without a card. In addition, they can provide you with information on how to get one.

Anonymous testing is a second option, since this does not require you to show your Health Insurance Card or any other piece of identification. This service is offered in at least one CLSC in each administrative region of Quebec. This service is not offered automatically, you will need to ask for it when you make your appointment.

There is also Médecins du Monde Canada which provides services to certain populations, including refugees and the homeless.

I got tested… Now what?

What if the results are negative?

If your results are negative, it does not mean that you are immune, and will never get an STBBI. Your healthcare professional will discuss with you the strategies to keep up or put in place to reduce the risk of a new infection, or of contracting HIV. In addition, they will let you know when you should get tested again.

What if I test positive for an STBBI?

Your healthcare professional will provide you with treatment that should eliminate the infection fairly quickly. Most STBBIs can be treated with medication. For treatment to be effective, you must take every dose, even if you have no symptoms. It is recommended to abstain from sex through the duration of treatment.

Some infections, like herpes and the human papilloma virus (HPV) cannot be cured. However, with herpes for example, there are treatments to relieve symptoms, reduce the duration and frequency of flare-ups, and lower the risk of transmission.

What if I test positive for HIV?

Today, HIV treatments are more effective than ever. The life expectancy of a person living with HIV is nearly as long as the life expectancy of an uninfected person. The more rapidly the infection is detected and gotten under controlled after a person is infected, the better their chances of living a long, healthy life. Effective treatment can also greatly reduce the risk of transmitting HIV. Knowing your HIV status is a good way of maintaining your health and protecting your partners.

After diagnosis, you will have regular check-ups in order to control the infection and stay healthy. HIV treatment is covered by both private and public (RAMQ) health insurance.

Should you disclose your HIV status?

Telling someone that you are living with HIV can be stressful. It is impossible to predict how the other person will react. As a result, the vast majority of women living with HIV are selective about to who they disclose and when. For more information about disclosure or non-disclosure of your HIV status, refer to the site Pouvoir partager / pouvoirs partagés (French).

Choosing to disclose your HIV status involves real risks. In spite of scientific advances in the treatment of HIV, social prejudices have not changed very much. Discrimination, rejection, and even the criminalization of people living with HIV are still real challenges. And the fear that people living with HIV experience as a result of these realities is legitimate.

There is no magical, one-size-fits-all answer when it comes to deciding whether to disclose that you are living with HIV. The rule of thumb is to act with integrity, and make decisions that will allow you to protect yourself, and allow your partners to make informed decisions. One thing is certain, the decision to have sex and the responsibilities that come with it, whether you use protection or not, rests equally on both partners. This moral obligation on the part of both partners is widely recognized throughout the HIV community. However, legally, you should know that you could be prosecuted for failing to disclose your HIV-positive status to your partner.